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Pyrotinib Combined With Trastuzumab and AI in the First-line Treatment of HER2 Positive/ HR Positive MBC (Pyrotinib)

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ClinicalTrials.gov Identifier: NCT03910712
Recruitment Status : Not yet recruiting
First Posted : April 10, 2019
Last Update Posted : April 10, 2019
Sponsor:
Information provided by (Responsible Party):
Qiang SUN, Peking Union Medical College Hospital

Brief Summary:
This study is a randomized, open-label, phase II study, comparing the efficacy and safety of trastuzumab plus aromatase inhibitors, with or without pyrotinib, in the treatment of HR (hormone receptor)+/HER2 (human epidermal growth factor receptor 2) + MBC and inoperable LABC patients.

Condition or disease Intervention/treatment Phase
Breast Cancer Female HER2-positive Breast Cancer Hormone Receptor Positive Malignant Neoplasm of Breast Metastatic Breast Cancer Breast Diseases Hormone Receptor Positive Tumor Drug: Pyrotinib Drug: Trastuzumab Drug: Aromatase inhibitor Phase 2

Detailed Description:

This is a randomized, two-arm, open-label, multicenter phase II trial. Our primary purpose is to compare that PFS of patients with trastuzumab, AI plus pyrotinib and trastuzumab plus an AI for HER2-positive and hormone receptor-positive MBC or locally advanced breast cancer (LABC).

Eligible patients will randomized to a ratio of 1:1 to pyrotinib+ trastuzumab + aromatase inhibitor (experimental group) or trastuzumab+aromatase inhibitor (control group). Stratification factors were 1)time since adjuvant hormone therapy (<=12 months/>12 months/no prior hormone therapy); 2) lesion (visceral; non-visceral).

In treatment period, patients will be administrated trastuzumab plus aromatase inhibitors, with or without pyrotinib, every 21 days for 1 cycle, until disease progression, toxicity intolerance, withdrawal of informed consent, patients judged must be terminated study termination.

The imaging evaluation was performed according to the RECIST 1.1 criteria every 6 weeks.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 250 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomized, Open-label Study of First Line Pyrotinib, Trastuzumab With an Aromatase Inhibitors, in the Treatment of HER2 Positive and HR Positive Metastatic or Inoperable Locally Advanced Breast Cancer
Estimated Study Start Date : June 1, 2019
Estimated Primary Completion Date : June 1, 2022
Estimated Study Completion Date : December 1, 2023

Resource links provided by the National Library of Medicine

Drug Information available for: Trastuzumab

Arm Intervention/treatment
Experimental: Pyrotinib and trastuzumab plus aromatase inhibitor
Participants will receive pyrotinib in combination with trastuzumab plus AI until pre-defined study end, disease progression, unacceptable toxicity, withdrawal of consent or death, whichever occurs first.
Drug: Pyrotinib
Pyrotinib were administered 400 mg orally daily. Oral administration within 30 minutes after breakfast, and continuous administration for 21 days for 1 cycle.
Other Name: Study drug

Drug: Trastuzumab
Trastuzumab were administered every 3 weeks intravenously (8 mg/kg loading doses followed by 6 mg/kg maintenance doses).
Other Name: Herceptin®

Drug: Aromatase inhibitor
The investigator chose an aromatase inhibitor (either anastrozole, letrozole or exemestane 1 mg/2.5 mg/25 mg), once daily, oral.
Other Name: anastrozole, letrozole or exemestane

Active Comparator: Trastuzumab plus aromatase inhibitor
Participants will receive trastuzumab plus AI until pre-defined study end, disease progression, unacceptable toxicity, withdrawal of consent or death, whichever occurs first.
Drug: Trastuzumab
Trastuzumab were administered every 3 weeks intravenously (8 mg/kg loading doses followed by 6 mg/kg maintenance doses).
Other Name: Herceptin®

Drug: Aromatase inhibitor
The investigator chose an aromatase inhibitor (either anastrozole, letrozole or exemestane 1 mg/2.5 mg/25 mg), once daily, oral.
Other Name: anastrozole, letrozole or exemestane




Primary Outcome Measures :
  1. Progression-Free Survival (PFS) [ Time Frame: From randomization to 36 month ]

    PFS was defined as the time from randomization to first documented disease progression (PD) using Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) or death from any cause, whichever occurred first. For target lesions, PD was defined as at least a 20% increase in the sum of the longest diameter of target lesions, taking as reference the smallest sum of the longest diameter recorded since treatment started or the appearance of 1 or more new lesions. For non-target lesions, PD was defined as the appearance of 1 or more new lesions and/or unequivocal progression of existing non-target lesions.

    The PFS will be will be estimated using Kaplan-Meier method. A Kaplan-Meier curve, median PFS, hazard ratio with appropriate confidence intervals will be reported.



Secondary Outcome Measures :
  1. Overall Survival (OS) [ Time Frame: From randomization to 36 month ]

    Overall Survival (OS), defined as the time from the date of randomization to the date of death, regardless of the cause of death. Participants who were alive at the time of the analysis were censored at the date of the last follow-up assessment. Participants without follow-up assessment were censored at the day of last study medication and participants with no post-baseline information were censored at the date of randomization.

    The OS will be will be estimated using Kaplan-Meier method. A Kaplan-Meier curve, median OS, hazard ratio with appropriate confidence intervals will be reported.


  2. Objective Overall Response Rate (ORR) [ Time Frame: From randomization to 36 month ]

    ORR was defined as percentage of participants with best (confirmed) overall response (BOR) of either CR or PR. ORR was assessed by the investigator according to RECIST version 1.1 and is based on BOR, which is defined as best response recorded from start of study treatment until disease progression/recurrence or death. Participants needed to have two consecutive assessments of PR or CR to be a responder. Only participants with measurable disease at baseline were included in the analysis of BOR and who did not have any evaluable post-baseline assessments were classified as not evaluable.

    The ORR will be reported by percentage with each arms and appropriate confidence intervals.


  3. Duration of Response (DoR) [ Time Frame: From randomization to 36 month ]

    DoR is defined as date of initial confirmed PR/CR until date of progressive disease or death from any cause. PR or CR or SD is according to RECIST version 1.1.

    The DoR will be estimated using Kaplan-Meier method. Kaplan-Meier curves, median DoR, hazard ratio with appropriate confidence intervals will be reported.


  4. Time to Response (TTR) [ Time Frame: From randomization to 36 month ]

    Time to Response (TTR), defined as the time from the date of randomization to the date of first CR or PR. CR or PR is according to RECIST version 1.1.

    The TTR will be estimated using Kaplan-Meier method. A Kaplan-Meier curve, median TTR, hazard ratio with appropriate confidence intervals will be reported.


  5. Clinical Benefit Response (CBR) [ Time Frame: From randomization to 36 month ]

    CBR is percentage of participants with best (confirmed) PR or CR or SD for at least 6 months. PR or CR or SD is according to RECIST version 1.1.

    The CBR will be reported by percentage with each arms and appropriate confidence intervals.


  6. Adverse events (AEs) [ Time Frame: From screening phase until AEs returns to Grade 0-1 or baseline ]

    AEs were graded according to the National Cancer Institute's Common Toxicity Criteria for Adverse Events (CTCAE) version 4.0.3.

    In general, AEs are graded according to the following: Grade 1 Mild AE Grade 2 Moderate AE Grade 3 Severe AE Grade 4 Life-threatening or disabling AE Grade 5 Death related to AE.

    The type, grade and frequency of AEs will be reported.


  7. Quality of Life (QoL) by FACT-B [ Time Frame: From randomization to 36 month ]

    QoL was assessed using Functional Assessment of Cancer Therapy for Breast Cancer (FACT-B). FACT-B is a 37-item questionnaire with 5 subscales assessing physical, social, emotional, and functional well-being, as well as a breast cancer specific subscale.

    FACT-B questionnaires were completed by patients on screening phase (baseline) and each 6 weeks after randomization. Mean change from baseline of FACT-B scores by each visit for each arms will be reported.


  8. Quality of Life (QoL) by EQ-5D [ Time Frame: From randomization to 36 month ]

    QoL was assessed using EuroQoL 5-Dimensions (EQ-5D). EQ-5D is a standardized instrument developed by the EuroQol Group as a measure of health-related quality of life that can be used in a wide range of health conditions and treatments.

    EQ-5D questionnaires were completed by patients on screening phase (baseline) and each 6 weeks after randomization. Mean change from baseline of EQ-5D scores by each visit for each arms will be reported.




Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age≥18 years, female;
  2. Postmenopausal or pre-menopausal with ovarian function suppression;
  3. At least one measurable lesion evaluable according to Response Evaluation Criteria In Solid Tumors Version 1.1;
  4. Metastatic or inoperable local advanced breast cancer;
  5. HER2-positive breast cancer;
  6. HR-positive breast cancer;
  7. LVEF ≥50%;

Exclusion Criteria:

  1. Previous systemic non-hormonal anticancer therapy in the metastatic or advanced breast cancer setting;
  2. Received endocrine therapy within 7 days before randomization;
  3. Uncontrolled central nervous system metastases;
  4. Disease-free interval from completion of adjuvant/neo-adjuvant systemic non-hormonal treatment to recurrence of within 6 months.
  5. Other malignancies within the last 3 years, except for carcinoma in situ of the cervix or basal cell carcinoma.
  6. Major surgical procedure or significant traumatic injury within 28 days prior to study treatment start or anticipation of the need for major surgery during the course of study treatment
  7. Severe organ dysfunction as assessed by signs and symptoms, laboratory studies and rapid progression of disease, which leading to a clinical indication for chemotherapy.
  8. History of CHF of any New York Heart Association (NYHA) criteria, or serious cardiac arrhythmia requiring treatment (exception, atrial fibrillation, paroxysmal supraventricular tachycardia);
  9. History of myocardial infarction within 6 months of randomization
  10. History of LVEF decline to below 50% during or after prior trastuzumab neo-adjuvant or adjuvant therapy
  11. Pregnant or lactating women;
  12. QT interval>470 ms;
  13. Serious concomitant diseases (including severe hypertension, severe diabetes, active infection, thyroid disease, etc.) that are harmful to the patient's safety or affect the patient's completion of the study;

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03910712


Contacts
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Contact: Qiang Sun, M.D. 86-10-69158721 sunqiangpumch@sina.com
Contact: Changjun Wang, M.D. 86-10-69158721 wcj_sumy@126.com

Sponsors and Collaborators
Peking Union Medical College Hospital
Investigators
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Study Chair: Qiang Sun, M.D. Peking Union Medical College Hospital

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Responsible Party: Qiang SUN, Professor, Peking Union Medical College Hospital
ClinicalTrials.gov Identifier: NCT03910712     History of Changes
Other Study ID Numbers: BREAST-Pyrotinib
First Posted: April 10, 2019    Key Record Dates
Last Update Posted: April 10, 2019
Last Verified: April 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No

Keywords provided by Qiang SUN, Peking Union Medical College Hospital:
MBC, Pyrotinib, Trastuzumab, First line, HER2

Additional relevant MeSH terms:
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Breast Neoplasms
Neoplasms
Breast Diseases
Neoplasms by Site
Skin Diseases
Trastuzumab
Letrozole
Exemestane
Anastrozole
Aromatase Inhibitors
Antineoplastic Agents, Immunological
Antineoplastic Agents
Steroid Synthesis Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Estrogen Antagonists
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Antineoplastic Agents, Hormonal